Surgical time in gynecologic surgery using laparoscopic articulated instruments (KGOG 4002).

Objective: To estimate the learning curve of laparoscopic articulated instrument (LAI) surgery by analyzing data from a multi-institutional gynecologic surgery cohort using surgical time as the primary metric for evaluation.

Methods: A total of 400 patients scheduled to undergo gynecologic surgery (adnexal surgery, myomectomy, hysterectomy, and cancer surgery) using LAI were prospectively enrolled at 14 institutes in the Republic of Korea between November 2021 and April 2022 (KGOG 4002). After excluding patients who did not undergo surgery with LAI (n=43), those in whom LAI was rarely used (n=11), and those operated on by surgeons with prior LAI experience (n=147), 199 patients were included in the analysis. Changes in surgical time according to the surgery index were evaluated using linear regression analysis.

Results: Fifty-four adnexal surgeries, 40 myomectomies, 68 hysterectomies, and 37 cancer surgeries were performed by 24 surgeons. Each surgeon performed between one and 24 surgeries. Surgical time did not decrease as the surgery index increased for any type of surgery. Among surgeons who performed ≥10 surgeries, surgical time similarly showed no decrease with increasing surgery index.

Conclusion: In gynecologic surgery using LAI, surgical time did not decrease despite accumulating surgical experience.